The effect of use of traditional Chinese herbal formula in treatment of infertility in woman over 40 years of age

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1 The effect of use of traditional Chinese herbal formula in treatment of infertility in woman over 40 years of age 中药配方治疗 40 岁以上女性不孕症疗效分析 Jiaru Linda Tian Chief Physician 田家茹主任医师 New Zealand College of Chinese Medicine Kang Tai Med-Herb Clinic

2 Brief introduction of use of Chinese herbal medicine status in New Zealand and current context 新西兰使用中草药现状及环境简介 The use of Chinese herbal medicine hasn t been admitted in NZ, however acupuncture treatment can be used as a supportive way to treat infertility cases and is suggested by some of fertility specialists before or after IUI and IVF, but herbal medicine isn t be suggested to use. 在新西兰, 中药还没有被认可合法使用, 然而针灸治疗不孕症作为一个辅助方式被一些生育专家建议在人工受孕中使用, 但不建议使用中药 Lots of women especially over 40 years of age with infertility issues who have the lower rates success of conception and these people are looking for alternative medicine for the treatment to increase the fertility rate of success. 很多女性尤其是 40 岁以上的不孕不育者, 自然怀孕率低, 她们正在寻找另类治疗以提高生育成功率

3 Recently introduced IUI (Intra-uterine insemination) and IVF (In vitro fertilization) provide some results in battling infertility, but high complexity and cost as well as low effectiveness of these methods make alternative medicine an increasingly common complementary treatments. 目前推出的人工授精, 体外受精在治疗不孕症中取得了一些成果, 但是其高复杂性, 高成本及低有效率使得替代医学疗法有了越来越多的需求 So Chinese herbal medicine has the opportunity to be applied to treat these infertility cases, that is why I did this study. 因此中药就有机会应用于治疗这些不孕不育病例这就是为什么我做了这项研究学习

4 Article abstract This study explores and critically analyzes available literatures on a potential of utilization of traditional Chinese herbal formulas as complements in treatment of infertility. These literatures will be reviewed for the infertility cases of women over 40 years of age treated using TCM herbal formula. The outcomes sought are the improvement in eggs quality and ovulation, strengthening of kidney, heart, liver, spleen functions and ultimately improving the conception and fertility outcomes. 本研究通过探讨和审慎分析现有中医文献中使用传统中药配方治疗 40 岁以上不孕症的潜能和案例, 寻求的结果是改善卵子质量和排卵功能, 加强肝脾肾心的功能, 最终达到提高妊娠和生育的目的 Keywords: women over 40 years, infertility, TCM theory and herbal formula treatment. 关键词 :40 岁以上女性, 不孕, 中医理论和中药配方治疗

5 The theoretical basis for the treatment of infertility with TCM 中医治疗不孕症的理论基础 1.1 中医认识女性年龄与生育的关系 As every one knows that the success of reproduction is closely related to the age of women, and this view has been explained clearly by Huang di nei jing NeiJing. 众所周知妇女的生育成功与年龄密切相关, 这个观点早在黄帝内经就有明确的阐述 Neijing state: At fourteen years old, the tian kui matures, ren vessels open; chong vessels with blood are in excess; so the menstruation begins and the conception is possible. 黄帝内经言 : 二七而天癸至, 任脉通, 太冲脉盛, 月事以时下, 故有子.

6 At twenty-eight years, the bones and tendons are strong; and the hair and secondary sex characteristics are complete. This is the height of female development 四七, 筋骨坚, 发长极, 身体盛壮 At forty-two years, the three yang channels are decline in the upper part; and the entire face is wrinkled; and the hair begins to turn gray 六七, 三阳脉衰于上, 面皆焦, 发始白 At forty-nine years, ren and chong channels are deficient; and tian kui dries up. Hence the flow of the menses ceases; and the woman is no longer able to conceive. 七七, 任脉虚, 太冲脉衰少, 天癸竭, 地道不通, 故形坏而无子也

7 Analysis of TCM theory 中医理论分析 Neijing shows that the reproductive function of women begins at 14 years getting mature, at excess of essence with strong body period at 28, and then gradually declines. 这说明了妇女的生殖功能是由成熟期旺盛期而逐渐转衰的过程 Although there is a normal menstrual cycle for women over the age of 40, but their Tiankui, qi and blood at Chong Ren are gradually deficient. So for TCM views that reproduction is mainly related to the heart, liver, spleen and kidney organs, especially the kidney organs. 40 岁以上的女性尽管有一个正常的月经, 但天癸渐竭冲任气血渐衰少, 卵巢逐渐衰退, 这在中医看来主要与心, 肝, 脾, 肾等脏腑有关, 特别是肾脏 Because the kidney stores Tiankui essence and governs reproduction, when the kidney qi is strong and functional, and the blood is abundant, then the tiankui is mature with ovulation, the menses coming regularly, so conception is possible. 肾主生殖, 主藏精, 当肾气盛, 经血充沛, 天癸至, 月事以时下, 两精相遇, 则可受孕

8 Consequently, infertility is most related with kidney. But spleen and stomach are acquired foundation, the source of the qi and blood, if the spleen is deficient, the kidney essence is unable to get nourished and then the eggs becoming immature, and the blood is deficient as well, hence the conception is impossible. 因此, 不孕与肾的关系最为密切但是, 脾胃为后天之本, 气血生化之源, 如果脾气虚, 肾精肝血皆不足, 冲任脉空虚, 自然无法受孕 Therefore, the main principles of treating infertility for women over 40 years old are: to tonify spleen and kidney, reinforce yin essence and blood, sooth the liver qi and regulate qi and blood at the chong ren vessels, so when the organs of spleen, kidney and liver are functional, and menstrual cycles are regular, the conception will be occur. 所以中医治疗 40 岁以上女性不孕症的重点是温脾肾填精益血疏肝理气调理冲任气血使经调病除, 则胎孕可成

9 1.2 中医认识女性生理周期 A normal menstrual cycle is a sign that indicates a normal reproduction of women. From the theory of yin and yang, the menstrual cycle is a process of growth and decline of yin and yang. At the beginning of the cycle, the yin starts and then growth, when the yin is extreme at the half cycle, it turns into yang; then the yang starts growth, when the yang reaches to extreme at the second half cycle, menstruation occurs, then it turns into yin 女性月经正常是女性生殖功能正常活动的表现从阴阳学说而言, 月经周期是一个阴阳消长的过程, 月经周期的开始, 就是阴长的开始, 阴长半月而达重阴, 重阴必阳, 阳开始长, 阳长半月而达重阳, 重阳必阴廖宝彩 (2) Therefore, a normal menstrual cycle can be classified into 4 stages. After period, yin growth and yang decline stage; ovulation period, extreme yin transforms into yang stage; before period, yang growth and yin decline stage; menstruation period, extreme yang turns into yin. so treating infertility should follow this rules. 所以一个正常的女性月经可以分为四个阶段, 经后期 ( 阴长阳消 ) 排卵期 ( 重阴转阳 ) 经前期 ( 阳长阴消 ) 月经期 ( 重阳转阴 ) 治疗不孕症也应该按照女性月经周期的阴阳转换进行调理, 以顺应女性的生理规律

10 1.3 中医认识 40 岁以上女性的生理及不孕症的特点 Women over 40 years of age, her kidney function will decline fast, and her eggs quality and quantity are not at the good level, clinically most infertility cases caused by these common syndromes such as liver and kidney yin deficiency, spleen and kidney yang deficiency, liver qi stagnation and blood stasis, depression etc. 女性 40 岁以后生理上肾功能快速衰退, 卵巢储备多有不足, 以肾虚肝肾阴虚脾肾阳虚较为多见 ; 而且由不孕导致的精神抑郁烦躁常伴有肝郁气滞及血瘀等症候 Clinical symptoms like irregular menses, lumbar sore, easy be tired, hard to get pregnancy or easy to miscarriage etc. 临床多表现为月经失调腰酸乏力, 难以怀孕或怀孕后易流产等

11 The deficiency syndromes usually caused by liver, kidney yin deficiency, Chong Ren with blood deficiency, eggs are immature and her physiological menstrual cycle coming earlier; the excess syndromes mainly caused by cold uterus, blood stasis, dampness-phlegm blocks qi, ovulation blockage and her physiological menstrual cycle coming late. 虚症多因肝肾阴虚, 冲任血海亏乏卵子不成熟, 生理周期多表现为月经先期 ; 实证多由寒凝胞宫, 瘀血内停, 痰湿阻气, 排卵功能受阻, 生理周期表现为月经后期 Hence, according to TCM theory, the treatment for infertility cases of women over 40 years old should adhere to physiological rule of yin and yang; strengthen the liver, spleen, kidney and heart functions; and improve the quality of eggs and ultimately improving the conception and fertility outcome. 因此治疗 40 岁以上女性不孕症, 应根据中医理论, 遵循其阴阳生理规律, 加强肝脾肾心的功能, 提高卵子质量, 以达到提高怀孕及孕育的成功率

12 2.Traditional Chinese herbal formula in treatment of infertility in women over 40 years of age 中药配方治疗 40 岁以上女性不孕症 2.1 Menstrual cycle therapy in treatment of infertility by using Chinese herbal formula 中药周期疗法治疗不孕症 The principle of menstrual cycle therapy in treatment of infertility by using Chinese herbal formula are: I. After period: nourish kidney and liver and replenish yin and blood (ovarian development) II. III. IV. During the ovulation: warm the kidney and assist yang, regulate qi and blood, promote the transformation of yin and yang (promote ovulation) Before period: tonify the kidney and regulate qi and blood (Luteinizing generation) Menstrual period: sooth the liver qi and promote blood circulation (Bleeding) 治疗女性 40 岁以上不孕症采用中药周期疗法是 : 经后期 - 滋肾阴, 养肝血 ; 经间期 - 温肾助阳, 调理气血, 促进阴阳转化 ; 经前期 - 平补肾气, 和调气血 ; 月经期 - 疏肝理气, 理血调经罗颂平 (11)

13 It is said That blood is the root of women, any physiological functions can t do without blood, such as menstruation, pregnancy, born children, all these activities will consume the blood. 妇女以血为本, 以血为用, 经孕产易耗血伤气中药的月经周期治疗方法体现了补肾阴养血, 促卵巢发育 ; 温肾阳理血, 促近排卵 ; 温肾气调血, 促黄体生成 ; 疏肝理气以调正常月经 This emphasizes that women over 40 years of age, ovarian function is deficiency, and eggs quality and quantity are all at the lower level. Through menstrual cycle therapy, it will improve ovarian function 强调 40 岁以上卵巢功能低下, 通过中药周期疗法改善卵巢功能, 提高卵子数量昂质量

14 Chinese herbal formulas in treatment 中药配方举例 : After period: modified Gui shao di huang decoction: 经后期 :( 排卵前 ) 滋补肝肾, 养血凉血归芍地黄汤加减生地黄 12g, 山茱萸 9g, 山药 9g, 女贞子 9g, 旱莲草 12g, 白芍 9g, 当归 9g, 牡丹皮 9g, 茯苓 9g, 泽泻 9g, 炙甘草 4g. ( 根据每月变化加减麦冬 9g, 栀子 9g, 知母 12g, 赤芍 9g.) Before period: herbal formula: 经前期 :( 排卵后 ) 温肾阳, 调血固冲脉当归 9g, 白芍 9g, 赤芍 9g, 丹参 9g, 益母草 9g, 菟丝子 18g, 巴戟天 12g, 肉桂 9g, 淫羊藿 12g, 炙甘草 4g. ( 根据每月变化加减续断 12g, 川芎 6g)

15 Gao jing min suggested to use the basic formula, then modify this formula to the treatment in the 4 stages. 高静敏 (10) 根据妇女月经周期中阴阳转化消长的规律, 采用中药基本方加减治疗 : 黄芪 30g, 当归 10g, 茯苓 10g, 党参 15g, 熟地黄 20g, 白芍 10g, 陈皮 6g, 砂仁 6g, 淫羊藿 15g, 巴戟天 15g, 肉桂 3g, 甘草 5g. 经前期加菟丝子 15g, 杜仲 15g, 续断 5g; 月经期不用药 ; 经后期增加熟地黄白芍用量, 并加山楂 10g, 鸡内金 10g; 排卵期加桃仁 10g, 红花 10g, 益母草 15g, 牛膝 10g; 取得了显著效益笔者认为此基本方特点以补肾健脾化湿, 补血温胞宫, 加强先天与后天之本, 排卵期增强活血化瘀, 定能增强不孕疗效而显著提高受孕率, 特别是对排卵障碍不孕有显著效益

16 Du xin using the formula to warm the kidney and regulate menstruation for treating infertility with ovulation dysfunction caused by kidney yang deficiency 杜鑫等 (3) 采用温肾调经助孕汤治疗肾阳虚型排卵障碍性不孕, 采用处方 : 淫羊藿紫石英各 15g, 菟丝子 15g, 当归 12g, 川芎 10g, 赤芍 15g, 丹参 15g, 鸡血藤 15g, 香附 12g, 生甘草 6g. 月经期 (1-5 天 ) 重用赤芍丹参经后期 (5-14 天 ) 以滋阴养血为主, 兼顾补肾活血, 重用菟丝子, 利于卵泡发育, 子宫内膜增厚, 排卵期, 以理气活血为主, 重用赤芍丹参香附等, 经前期, 促黄体生成此方的特点是针对肾阳虚者, 胞宫寒而血形不畅, 导致排卵障碍, 遂以温肾阳理气活血为主助卵泡发育而顺利排出, 提高了怀孕成功率

17 3. Analysis and critical thinking of the effect by using Chinese herbal formula in treatment of infertility over 40 years of woman 中药治疗 40 岁以上女性不孕症的疗效分析与思考 3.1 The analysis of the clinical effect by using herbal formula Through reviewed the literatures and my own clinical experiences for the infertility cases of women over 40 years of age treated using TCM herbal formula., The outcomes sought are the improvement in eggs quality and ovulation, it has clinical significant benefits and worth to continue to pay attention. 笔者通过对使用中药配方治疗不孕症的中西文献案例进行研究及本人在临床的治疗经验, 结果可以看出中药配方治疗 40 岁以上女性不孕症能提高卵子质量和排卵功能, 具有临床重要效益, 值得继续重视和关注 Using Chinese herbal formula will follow the menstrual cycle changes of yin and yang, strengthening of kidney and spleen functions, sooth the liver qi, harmonies heart and kidney, tonify and regulate blood and resolve blood stasis and ultimately improving the conception and fertility outcomes. 中药配方治疗顺应月经周期阴阳变化, 从整体出发, 补脾肾疏肝理气交通心肾补血理血活血化瘀调整了肾 - 天癸 - 冲任 - 胞宫 - 生殖轴, 肾气盛而天癸至, 气血通畅, 则胎孕有成, 从而提高了怀孕的成功率和生育率

18 3.2 Critical thinking of the effect by using Chinese herbal formula 对中药配方治疗 40 岁以上不孕症的思考 Even though the clinical application of Chinese herbal medicine in most countries hasn t been legally recognized yet, but as a first line of TCM practitioners, I thought we should actively report the clinical outcomes of using Chinese herbal formula in treatment of infertility cases 尽管中药的临床应用在绝大多数西方国家目前还没有被合法的承认和认可, 但是作为工作在第一线的中医药工作者我们要积极宣传报道中药治疗不孕症的效果 The biggest advantages of TCM is a clinical practice, what ever in ancient or recent time, through practice we have accumulated lots of valuable experiences, and this is a great contributions to human reproduction. 传统中医药的最大优势就是临床实践, 无论古代现代中医都在临床实践中积累了许多宝贵的经验, 对人类的生殖繁衍做出了巨大的贡献

19 We want the whole world to know, to understand how good, and charm of Chinese medicine, we must show them the effects. 我们要让世界认识中医中药的魅力也必须让事实说话, 从疗效入手 Therefore, I believe that it isn t a person or one generation who can complete the work, like the ancient herbalist Li Shizhen spent 27 years for seeking and studying the herbs; as long as we don t give up of this, I think that Chinese herbal medicine would be accepted by the world and its contribution and influence is immeasurable. 笔者认为, 这不是一个人或一代人可以完成的, 就像古代中药巨匠李时珍花费 27 年走遍千山万水研究中药只要有恒心, 不放弃, 相信中药对人类的贡献和影响是不可估量的

20 参考文献 1) 赵瑞华. 妇科常见病治疗调养全书. 化学工业出版社 ) 廖宝彩. 台北县中医会刊杂志月经周期与过期疗法 2007,12 (40) 3) 杜鑫, 王雪, 范丰田, 袁启霞温肾调经助孕汤联合中药人工周期治疗肾阳虚型排卵障碍性不孕症的疗效评价 2013,17,21. 4) 任磊. 中药周期疗法治疗痰湿型排卵障碍性不孕症的临床疗效观察 [J].2012.(17):67. 5) 吕泽康. 赵可宁. 中药补肾调周法治疗不孕症排卵障碍证治摄要 [J]. 吉林中医药 2012, 32(2): ) 江丹. 中药针灸加强排卵周期的促孕治疗经验环球中医药 2011, (4):23. 7) 江志扬, 苏咏明. 中药治疗排卵障碍性不孕症 420 例临床效果分析 [J] 世界中医药,2014,(9)5:584 8) 卢金玉王清华蔡连香姜坤补肾疏肝法治疗排卵功能障碍不孕症的临床观察成都中医药大学学报 2000,(1):23. 9) 范晓迪, 马堃, 单婧等. 补肾活血促卵方治疗排卵障碍性不孕症的疗效观察 [J]. 中国中药杂志 2013, 38(1): ) 高静敏. 中药调周法联合针灸治疗排卵障碍性不孕症临床疗效观察天津中医药大学学报 (2014) ) 罗颂平, 中医药在高龄女性助孕安胎的应用, 中国妇产科在线 12) 庞玉琴. 四逆散加味治疗不孕症 60 例. 陕西中医 2003.(24)5: ) 傅青主女科. 中医宝典 14) Lyttleton J. (2013). Treatment of Infertility with Chinese Medicine. London: Churchill Livingstone. 15) Laufer N, Simon A, Samueloff, A, Yaffe H, Milwidsky A, Gielchinsky Y. Successful spontaneous pregnancies in women older than 45 years. Fertility and Sterility. 2004; 81 (5): ) Inga Heese. The egg factor: Using Chinese herbal medicine to improve fertility in a 45-year old woman The Journal of Chinese medicine. Retrived 17) 18) Wing T & Sedlmeier ES (2006). Measuring the effectiveness of Chinese herbal medicine in improving female fertility. The Journal of Chinese Medicine. 80: ) Yarde F. (2014), Advanced Ovarian Ageing:Studies on Fertility and Vascular Health Utrecht University. PDF. Printed by Gildeprint Drukkerijen BV, Enschede, the Netherlands.

本研究通过探讨和审慎分析现有中医文献中使用传统中药配方治疗 40 岁以上不孕症的潜能和案例, 寻求的结果是改善卵子质量和排卵功能, 加强肝脾肾心的功能, 最终达到提高妊娠和生育的目的本研究是一个桌面的文献综述作为一种数据收集方法, 根据同行在期刊和会议上发表的结果得出的结论关键词 :40

本研究通过探讨和审慎分析现有中医文献中使用传统中药配方治疗 40 岁以上不孕症的潜能和案例, 寻求的结果是改善卵子质量和排卵功能, 加强肝脾肾心的功能, 最终达到提高妊娠和生育的目的本研究是一个桌面的文献综述作为一种数据收集方法, 根据同行在期刊和会议上发表的结果得出的结论关键词 :40 The effect of use of traditional Chinese herbal formula in treatment of infertility in woman over 40 years of age Abstract Jiaru Linda Tian, Chief Physician New Zealand College of Chinese Medicine, Kang